Healthcare Provider Details

I. General information

NPI: 1497265995
Provider Name (Legal Business Name): MY LEGAL NURSE CONSULTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2017
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2607 15TH AVE SE
ST. CLOUD MN
56304
US

IV. Provider business mailing address

10608 ARROWHEAD ST NW
COON RAPIDS MN
55433-4013
US

V. Phone/Fax

Practice location:
  • Phone: 763-744-6192
  • Fax: 320-251-1486
Mailing address:
  • Phone: 763-744-6192
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number1813283
License Number StateMN

VIII. Authorized Official

Name: ROMANDA M GAYE
Title or Position: OWNER
Credential: REGISTERED NURSE
Phone: 763-744-6192